Publications by authors named "Brodbelt A"
Cranioplasty is an operation that aims to repair a defect in the skull. Indications commonly include Traumatic Brain Injury (TBI), tumours, and infections. It carries a high rate of postoperative morbidity.
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- A systematic review was conducted to analyze how outcomes of meningioma clinical trials are measured and reported, addressing the lack of agreement on these measures.
- The study reviewed 30 published articles and 18 ongoing trials, resulting in 47 clinical trials and 659 reported outcomes, which were grouped into unique terms using a standardized classification system.
- The findings highlight the need for a more consistent approach to outcome measurement, leading to plans for a consensus meeting to create a core outcome set to guide future trials.
Article Synopsis
- A systematic review was conducted to analyze how outcomes are measured in studies of patients with incidental intracranial meningioma, as inconsistent practices have hindered comparative research.
- The review included 33 published articles, resulting in 268 reported outcomes, which were refined to 178 unique outcomes categorized into 53 standardized terms and classified into 9 outcome domains.
- The goal is to create a Core Outcome Set through stakeholder consensus, improving the consistency of outcome measurements in future studies.
Background: Glioblastoma (GBM) brain tumors lacking IDH1 mutations (IDHwt) have the worst prognosis of all brain neoplasms. Patients receive surgery and chemoradiotherapy but tumors almost always fatally recur.
Results: Using RNA sequencing data from 107 pairs of pre- and post-standard treatment locally recurrent IDHwt GBM tumors, we identify two responder subtypes based on longitudinal changes in gene expression.
Article Synopsis
- * A study analyzing 39 adult patients with TPGs from 1993 to 2021 found that about 20% experienced tumor progression over a median follow-up of 10 years, with a high overall survival rate of 86.5%.
- * The study highlights the importance of identifying risk factors for TPG progression and suggests that future research should focus on larger cohorts for more definitive conclusions about long-term outcomes.
Article Synopsis
- * A systematic review was conducted to analyze patient-reported outcomes and health-related quality of life (HRQoL) after cranioplasty, with 25 studies included in the review.
- * Results showed improvements in physical and social functioning, cosmetic outcomes, and overall HRQoL, highlighting the need for more longitudinal studies using validated tools to better assess these effects.
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- Intracranial meningiomas involving bones and primary intraosseous meningiomas are rare, with no clear guidelines for treatment; this study reviews strategies and outcomes over a decade.
- A retrospective analysis of 33 adult patients reveals that most had secondary bone involvement, with many undergoing cranioplasty using various materials like polymethyl methacrylate and titanium mesh, showing a high success rate.
- The findings suggest that while different cranioplasty materials were effective, those that are pre-fabricated may lead to fewer complications, indicating the need for further research in this area.
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- Tranexamic Acid (TXA) is used to reduce bleeding during meningioma surgery, with a systematic review showing it significantly decreases intraoperative blood loss by about 316 mls.
- The analysis included four studies with 281 patients, but found no significant impact of TXA on transfusion needs, operation time, postoperative seizures, hospital stay duration, or long-term disability outcomes.
- Limitations of the review include a small sample size, insufficient data on secondary outcomes, and lack of a standardized blood loss measurement method, suggesting the need for larger trials to assess the full impact of TXA.
Article Synopsis
- After meningioma surgery, about one-third of patients have leftover tumors that need regular monitoring, but their growth rates are not well understood.
- The study focused on measuring the volumetric growth rates of these residual tumors in patients treated at a neurosurgery center from 2004 to 2020, using MRI scans and specific growth models.
- Results showed that most tumors grew slowly over time, with factors like tumor location and Ki-67 index helping to predict the likelihood of progression, which is important for determining treatment strategies.
Article Synopsis
- The study investigates long-term health-related quality of life (HRQoL) in meningioma patients, particularly those with tumors that are monitored but not surgically treated.
- Using patient-reported outcome measures, significant HRQoL impairments were found in various areas, especially for those with lower education levels, unemployment, or who faced postoperative complications.
- The findings emphasize the ongoing burden meningioma has on patients nearly a decade post-diagnosis, suggesting healthcare providers should pay attention to HRQoL and offer support resources accordingly.
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- Sporadic multiple meningiomas are rare and associated with lower overall survival compared to solitary meningiomas, but this study explores their clinical outcomes.
- A matched cohort study analyzed 34 patients with multiple meningiomas and found similar intervention rates, recurrence-free survival, and overall survival when compared to those with solitary meningiomas.
- The findings suggest that sporadic multiple meningiomas may not lead to worse outcomes, indicating that treatment should focus on symptomatic or high-risk asymptomatic cases.
Introduction: The prevalence of Chiari malformation type I (CM-I) has been estimated as up to 1% of the general population. The majority of patients are asymptomatic and usually do not need treatment. Symptomatic patients, and some asymptomatic patients with associated conditions, may benefit from further assessment and treatment.
View Article and Find Full Text PDFPurpose: For patients with a new lesion on CT head (CTH) suspected to be a brain tumor, a staging chest, abdomen, and pelvis CT (CTCAP) is only warranted if a metastatic lesion is suspected. Unnecessary CTCAPs are often performed too early in a patient's journey due to poor patient selection. We sought to create a protocol to guide the selection of patients for CTCAPs based on their CTH findings.
View Article and Find Full Text PDFBackground: We describe a case of long-standing intracranial hypotension caused by an iatrogenic arachnoid diverticulum. This case illustrates two learning points. First, excessive CSF absorption may occur through an acquired arachnoid-epidural venous plexus at a dural defect.
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- This study analyzed outcomes of first alloplastic cranioplasty in 287 patients, focusing on post-surgery complications and factors influencing the need for explantation, which is the removal of the implanted material.* -
- Most patients were around 43 years old, with traumatic brain injury being the leading reason for prior craniectomy; various materials, such as titanium and hydroxyapatite, were used for the cranioplasty.* -
- Results showed a 12.2% rate of all-cause explantation, with certain materials like hydroxyapatite and acrylic significantly lowering the risk of complications, while age and certain conditions increased the risk.*
Article Synopsis
- Meningiomas are the most common type of primary brain tumor in adults, mostly non-cancerous, but some can be aggressive, requiring different management strategies depending on symptoms and growth.
- Two specialized sets of outcomes (COS: Intervention and COS: Observation) will be created to standardize how results are measured in clinical trials and studies of incidental meningiomas.
- The study will utilize systematic literature reviews and focus group surveys to identify, categorize, and prioritize outcomes, with ethical approval and consent processes in place for participant involvement.
Article Synopsis
- Core Outcome Sets (COS) establish essential metrics for measuring and reporting on clinical trials within a specific health context, but none exist yet for neuro-oncology, which is crucial for effective research design.
- COS development must focus on scope, stakeholder engagement (including patients), consensus methods (like Delphi surveys), and dissemination plans.
- Challenges in neuro-oncology include diverse tumor classifications, varying symptoms based on tumor location, and differing treatment options, making it difficult to create a COS that is neither too narrow nor too broad, as highlighted in ongoing projects for specific conditions like adult glioma and pediatric brain tumor surgical interventions.
Background: Tumour Treating Fields (TTF) in combination with standard therapy, prolongs survival in patients with glioblastoma (GBM). The aim of the current study was to assess the feasibility of integrating TTF into a standard UK neuro-oncology service with a focus on patient tolerability, compliance, and treatment delivery.
Methods: A prospective study was performed of UK patients with IDH 1 Wild Type, MGMT Unmethylated GBM treated with TTF, in conjunction with conventional therapy.
Brain metastases comprise 40% of all metastatic tumours and breast tumours are among the tumours that most commonly metastasise to the brain, the role that epigenetic gene dysregulation plays in this process is not well understood. We carried out 450 K methylation array analysis to investigate epigenetically dysregulated genes in breast to brain metastases (BBM) compared to normal breast tissues (BN) and primary breast tumours (BP). For this, we referenced 450 K methylation data for BBM tumours prepared in our laboratory with BN and BP from The Cancer Genome Atlas.
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- Due to increased CT and MRI use, incidental findings like meningiomas in brain scans are becoming more common, with a prevalence of about 3 per 1000 scans.
- * A new statistical model, IMPACT, has been created to categorize patients with incidental meningiomas into risk groups and propose a monitoring strategy based on their individual progression risks.
- * The ongoing multicentre study will analyze data from 1500 patients to validate the effectiveness of the IMPACT model and ensure ethical standards are upheld during data collection and dissemination.
Objective: Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws.
View Article and Find Full Text PDFThe outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted.
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